One year after 17 Oregon hospitals put a “hard stop” on elective, non-medically necessary inductions and c-sections prior to 39 weeks gestation, some hospitals are showing trends of significant reduction in early elective deliveries (EEDs).  By September 1, 2011, 17 of the Oregon’s 53 birthing hospitals joined the March of Dimes / Oregon Health Leadership Council (OHLC) “hard stop” challenge. Those 17 hospitals accounted for nearly 50% of all Oregon births. The Oregon Association of Hospitals and Health Systems are a partner in this work, helping hospitals to eliminate patient harm through the CMS Partnership for Patients (PfP) campaign. With our combined efforts 35 of Oregon’s 53 birthing hospitals have adopted a “hard stop” policy on early elective deliveries.  The results are astounding..

After a year of declaring Healthy Babies Are Worth the Wait, Oregon hospitals are showing decreases in EEDs by as much as 86%.

• Providence Portland Medical Center reports a 62% decrease, going from an EED rate of 16.7% to 6.3%
• Providence St. Vincent’s Medical Center reports a 56% decrease, going from an EED rate of 9.6% to 4.2%
• Providence Medford Medical Center reports a 61% decrease, going from an EED rate of 13.1% to 5.1%
• Providence Hood River Medical Center reports an 81% decrease, going from an EED rate of 21.2% to 4.0%
• Tuality Healthcare is reporting an 86% decrease, going from an EED rate of 9% to 1.3%
•  Kaiser Permanente reported ending 2011 with EEDs at 2.83% and falling

“All Legacy Health Family Birth Centers are experiencing a decrease in early elective deliveries since the ‘hard stop’ was put in place, including Salmon Creek which is below 4.5%.” said Helen Phillips, Director of Women’s Health at Legacy Emanuel.

Last summer, when March of Dimes Greater Oregon, OHLC and the Oregon Health Authority (OHA) led the “hard stop” challenge with the Healthy Babies Are Worth the Wait campaign, the goal was to lower early term births because research has shown that a baby’s brain nearly doubles in weight in the last few weeks of pregnancy, and important lung, liver and kidney development also occurs at this time. Morbidity rates double for each gestational week earlier than 38 completed weeks, and the risk of death is nearly double for infants born at 37 weeks of pregnancy, when compared to babies born at 40 weeks, for all races and ethnicities.

Early term elective deliveries have an impact on late preterm birth rates. The “hard stop” implemented with the Healthy Babies Are Worth the Wait campaign was in effect for a solid three months of 2011; which could be a contributing factor to the 8% decline in preterm births in Oregon last year.

In the March of Dimes Premature Birth Report Card, released today, Oregon’s preterm birth rated dropped from 9.9% in 2010 to 9.1% in 2011, earning Oregon an “A” on the report card, second only to Vermont. Of the four states earning an “A” this year (three more than last year), Oregon had the highest percent decrease in premature birth at 8%, followed by Vermont at 5%, New Hampshire at 4% and Maine at 3%.

With three of the four “A” states in the Northeastern-most tip of the U.S., Oregon has the only “A” west of New York.

“The March of Dimes campaign, Healthy Babies Are Worth the Wait, encourages women to allow labor to begin on its own if their pregnancy is healthy and aims to dispel the myth that it’s completely safe to schedule a delivery before 39 weeks of pregnancy without a medical need,” said Joanne Rogovoy, State Director of Program Services and Public Affairs for March of Dimes Greater Oregon Chapter. “And the numbers show it’s really making a difference.”

Babies born too early may have more health problems at birth and later in life. Here’s why babies need 39 weeks:

• Important organs, like the brain, lungs and liver, get all the time they need to develop.
• Babies are less likely to have vision and hearing problems after birth.
• Babies born too soon often are too small. Babies born at a healthy weight have an easier time staying warm than babies born too small.
• Babies can suck and swallow and stay awake long enough to eat after they’re born. Babies born early sometimes can’t do these things.

Information about the new Healthy Babies Are Worth the Wait educational campaign can be found at marchofdimes.com/39weeks.

The 35 hospitals committed to this effort are: the hospitals of Providence Health and Services, Kaiser Permanente, Tuality Health Care, the hospitals of Legacy Health, Oregon Health & Science University (OHSU), Adventist Medical Center, Salem Health, St. Charles Medical Center in Bend, Rogue Valley in Medford, the hospitals of PeaceHealth, the hospitals of Samaritan Health Systems and more.

GLOSSERY

• Preterm – less than 37 weeks gestation
• Late Preterm – between 34-0/7 weeks and 36-6/7 weeks gestation
• Early Term – between 37-0/7 and 38-6/7 weeks gestation
• Elective Induction – induction of labor without an accepted medical or obstetric indication before the spontaneous onset of labor or rupture of membranes
• Elective Cesarean – scheduled primary or repeat cesarean without an accepted medical or obstetric indication before the spontaneous onset of labor or rupture of membranes

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